Category Archives: Hygiene Promotion

A new report by the World Health Organization (WHO and Unicef provides an “alarming picture of the state of WASH in health care facilities”.

Drawing on limited data from 54 low- and middle-income countries the report concludes that 38% of the facilities lack access to even rudimentary levels of water, 19% lack sanitation and 35% do not have water and soap for handwashing.

In addition, “training and capacity building to ensure there are sufficient resources and personnel to operate and maintain WASH facilities and enable health care staff to deliver hygiene behaviour change messages is urgently needed”, the report says.

“While the situation appears bleak, there are a number of global initiatives for which WASH in health care facilities is a foundational element and examples of national governments taking the initiative to improve standards, implementation and monitoring”, the report concludes. Through coordinated, global action, with leadership from the health sector, WHO and Unicef believe that all health care facilities can have adequate WASH services.

To identify household-level factors associated with influenza among young children in a crowded community in Dhaka, Bangladesh. Case households were more likely than controls to have crowded (≥4 persons) sleeping areas and cross-ventilated cooking spaces. Case and control households had similar median 24-hour geometric mean PM2.5 concentrations in the cooking and sleeping spaces. Handwashing with soap was practiced infrequently, and was not associated with pediatric influenza in this community. Interventions aimed at crowded households may reduce influenza incidence in young children.

Getting the basic rights – the role of water, sanitation and hygiene in maternal and reproductive health: a conceptual framework. (Full text)
WASH affects the risk of adverse maternal and perinatal health outcomes; these exposures are multiple and overlapping and may be distant from the immediate health outcome. Much of the evidence is weak, based on observational studies and anecdotal evidence, with relatively few systematic reviews. New systematic reviews are required to assess the quality of existing evidence more rigorously, and primary research is required to investigate the magnitude of effects of particular WASH exposures on specific maternal and perinatal outcomes.

LANCET INFECTIOUS DISEASES – FEB 2015

Editorial – Prioritising clean water and sanitation (Free full text but registration required)
Sanitation is the single greatest human achievement with regard to health, yet in much of the world it is underappreciated or inaccessible. Talha Burki investigates. “Currently, the popular approaches to sanitation place a lot of responsibility on individuals and households and not as much on governments”, adds WaterAid’s Yael Velleman. In the UK, it was legislation that led to universal access to improved sanitation. “Ultimately, it was political will and public finance that pushed that drive—I wonder whether we now expect low-income countries to do something we have never done ourselves”, said Velleman. Pollock advocates a return to a health-for-all approach, attending to the building blocks of public health, such as sanitation and nutrition, and directing major investment into infrastructure and monitoring systems. “I can’t understand why we’re prioritising clinical trials in Africa, and not prioritising clean water”, she told The Lancet Infectious Diseases.

Guest editorial: tackling the stigma and gender marginalization related to menstruation via WASH in schools programmes(abstract/order info)
Menstrual hygiene management has been defined as: ‘Women and adolescent girls using a clean menstrual management material to absorb or collect blood that can be changed in privacy as often as necessary for the duration of the menstruation period, using soap and water for washing the body as required, and having access to facilities to dispose of used menstrual management materials’ (UNICEF and WHO, 2014). However, menstrual hygiene is not just about the management of the menstrual period but also the need to address societal beliefs and taboos surrounding the issue.

Until recently, the development sector including WASH (water, sanitation and hygiene) had not explored and attempted to address the challenges related to Menstrual Hygiene Management (MHM), an important issue affecting the health, dignity and privacy of millions of girls and women on a daily basis. It is great to have a whole issue of Waterlines dedicated to MHM, as it will help us, the maledominated, engineering-based sector, to increase our understanding of this aspect of the development work we do on a daily basis.

Mainstreaming menstrual hygiene management in schools through the play-based approach: lessons learned from Ghana(full text)
The study objective was to identify and document the effectiveness of the play-based approach in promoting menstrual hygiene management (MHM) in schools and share lessons learned. The study used a mix of approaches including qualitative and quantitative techniques. The author carried out an exploratory evaluation on the promotion of MHM activities as part of WASH in Schools programmes in 120 public schools in Ghana. Comparison was drawn between 60 schools currently using the play-based approach in promoting MHM, and 60 schools which are not using the play-based approach.

Developing games as a qualitative method for researching menstrual hygiene management in rural Bolivia(abstract/order info)
In 2012, Emory University and UNICEF conducted a multi-country formative study to gain a global perspective of girls’ experiences. A compendium of tools was created to ensure investigation of common themes across all settings. This paper describes the process of adapting the focus group discussion (FGD) tool for Bolivia into a board game as a method to ease girls’ discomfort discussing menstruation and elicit richer data.

The association between hygiene, sanitation, and health is well documented, yet thousands of children die each year from exposure to contaminated fecal matter. At the same time, evidence on the effectiveness of at-scale behavior change interventions to improve sanitation and hygiene practices is limited.

This paper presents the results of two large-scale, government-led handwashing and sanitation promotion campaigns in rural Tanzania. For the campaign, 181 wards were randomly assigned to receive sanitation promotion, handwashing promotion, both interventions together, or neither. One year after the end of the program, sanitation wards increased latrine construction rates from 38.6 to 51 percent and reduced regular open defecation from 23.1 to 11.1 percent.

Households in handwashing wards show marginal improvements in handwashing behavior related to food preparation, but not at other critical junctures. Limited interaction is observed between handwashing and sanitation on intermediate outcomes: wards that received both handwashing and sanitation promotion are less likely to have feces visible around their latrine and more likely to have a handwashing station close to their latrine facility relative to individual treatment groups.

Final health effects on child health measured through diarrhea, anemia, stunting, and wasting are absent in the single-intervention groups. The combined-treatment group produces statistically detectable, but biologically insignificant
and inconsistent, health impacts. The results highlight the importance of focusing on intermediate outcomes of take-up and behavior change as a critical first step in large-scale programs before realizing the changes in health that sanitation and hygiene interventions aim to deliver.

We would like to announce our next practice-oriented Eawag course on the topic of “Systematic Behaviour Change in Development Projects”. The applied course will take place on March 5 – 6, 2015, at Eawag Dübendorf.

The course will enable participants to plan, design, and evaluate evidence-based behaviour change campaigns. The participants will learn how to conduct a quantitative survey of behavioural determinants, how to identify the required behaviour change techniques and how to prove the effects and effectiveness of these techniques.

A live presentation of Dr. Kamal Kar about the CLTS<cltsfoundation.org/> approach and a Q&A session will be an integrated part of the course.

Like this:

WHO is launching a global plan of action to improve access to WASH at all health care facilities. This kind of intersectoral collaboration is set to become a major theme in the post-2015 development agenda.

Better access to water, sanitation and hygiene (WASH) in health care facilities is crucial for mothers and babies to stay healthy. It is just as important as curative measures says Dr Maria Neira, the Director of Public Health and Environment at the World Health Organization (WHO) [1]. She announced that WHO will launch a global plan of action by March 2015 on improving access to WASH at all health care facilities [2].

Measurement of handwashing behavior: Based on a review of numerous studies using structured observation to measure behavior, hands are washed with soap after approximately 19 percent of events that involved using the toilet or coming into contact with a child’s excreta.1

Behavior change communication: The much-awaited results from the Super-Amma campaign, a handwashing behavior change intervention based on emotional drivers such as nurture and disgust, have started to come in. These results show that this approach to handwashing promotion has lasting impact and is achieving the diffusion of handwashing as a social norm.2,3 The campaign provides further confirmation that the knowledge of handwashing benefits is linked to its practice4,5 and that women’s participatory groups6 and handwashing education in schools,7 including students’ involvement in hygiene and sanitation clubs,9 are good settings in which to build that knowledge into action. Furthermore, the mere act of checking whether households have soap seems to increase their handwashing behavior.10

Handwashing hardware: The studies reviewed provide further evidence that the availability of appropriate handwashing stations and soap in schools,7 healthcare centers,8 and in the home12,13 increases handwashing prevalence, as does having piped water and functioning sewage mechanisms.14 Research provided further evidence that soap and ash are equally effective at cleaning hands,15 and that 4g of moringa oleifera leaf powder shows promise as an effective alternative to soap or ash for handwashing.16

Benefits of handwashing: A review estimated that handwashing with soap reduces the risk of diarrhea by 40 percent.1 Excluding the studies that could theoretically have been biased (or unblinded)—researchers knowing which people were exposed to handwashing interventions and which were not— handwashing with soap was estimated to reduce the risk of developing diarrhea by 23 percent.1 Further evidence showed that having soap in the home reduces children’s episodes of diarrhea, acute respiratory infections, eye infections, helminth infections, and school absences.18,19,20,21 It was found that good handwashing interventions in school also reduce school absences (but only for girls in one study)7 and that school-based interventions reduce episodes of diarrhea in preschool-aged siblings.17

Contamination: Various studies measured hands contaminated with rhinovirus,22 E coli,5, 25and helminth eggs.23 One study inversely correlated prevalence of handwashing with the amount of influenza virus found on household surfaces.24 A final study showed that in the rural areas hands revert to baseline levels of contamination within one hour after handwashing with soap.26

Please join the Global Public-Private Partnership for Handwashing (PPPHW) for a webinar on April 7 at 9:00AM EST to celebrate this year’s World Health Day theme: food safety. Food hygiene is a particularly relevant topic for those of us working in handwashing. Join this webinar to: - Explore why food hygiene matters for child health in the global context, - […]

While the findings of the new WHO report on WASH in healthcare facilities are indeed grim (and might I actually add that there are so many limitations to the current data presented in the report that conditions are most likely a lot worse than reported) I am very excited that this report has come to light. All data in the report is secondary - meaning it […]

Hi Elisabeth, Of course - I currently work for WaterAid as a policy officer (health / monitoring and accountability). One of the projects I am currently working on involves working collaboratively with the WASH and NTD sectors to develop joint indicators for monitoring. My passion for WASH and health, and specifically integration with NTDs stems from my MSc […]

Composting is commonly used as an effective means of stabilizing wastewater biosolids and reducing pathogens to very low concentrations. However, it has been shown that under certain conditions Salmonella can regrow in previously composted biosolids. Growth of seeded Salmonella typhimurium in composted biosolids ranging from two weeks to two years maturity w […]

Hi Joe, What studies did you read? Why would anyone expect the finished ''biosolids'' (which are almost indistinguishable from soil) to become sterile? What would pathogenic microbes adapted to living in water without oxygen in our guts have to do in a pile of dry soil? Plus it is obvious that if there is new fecal contamination, the prev […]

The Africa APPG together with Polygeia seeks to explore the lessons from the Ebola crisis for community-led health systems strengthening through examining the current response to the Ebola crisis, and gathering evidence from experts and the affected communities in West Africa.

Communities declared Open Defecation Free (ODF) through Community Led Total Sanitation (CLTS) did not experience any case of the Ebola outbreak, despite other surrounding communities in Marbibi county that experienced the worst cases.

The CLTS Knowledge Hub is hosting a webinar on Participatory Design Development for Sanitation on Thursday 26th March 2015 at 10am GMT. Ben Cole will be discussing his experiences in applying participatory design to accompany and extend Malawi’s national CLTS program since 2012